Baclofen is now used in treatment of patients with severe spasticity secondary to neurological diseases through the direct infusion of the drug into the subarachnoid space with an implanted programmable pump. Among patients whose quality of life improved after the use of intrathecal systems, a very important role belongs to people with multiple sclerosis (MS): a disease that due to a great variety of symptoms and signs, seriously affects the activities of daily living. Among the clinical manifestations of MS are also found mental health problems including depression mood. The drugs most commonly offered, for treatment of depression in patients with MS, are selective serotonin reuptake inhibitors (SSRIs), reuptake inhibitors of serotonin and norepinephrine (SNRIs) and tricyclic antidepressants (TCA). Duloxetine presents a high affinity for transporters reuptake of serotonin and noradrenalin, and exerts its activity on both molecules. In addiction, Duloxetine has demonstrated very effective in treatment of depressive disorders of mood as demonstrated by scientific evidences about the utility of Duloxetine in the modulation of painful physical symptoms associated with depression and in treatment of pain associated with diabetic neuropathy. The purpose of our study is to evaluate the effects of antidepressant therapy with duloxetine, 60 mg/day in 7 patients with multiple sclerosis treated with intrathecal baclofen for spastic modulation of tone. The experience we gained, according to data from several multicenter trials confirmed the efficacy of Baclofen intrathecally administered, especially with regards to modulation of spasticity. Our study also showed, although the limitations of a small sample size still, a good clinical response to combined treatment Baclofen intrathecal/duloxetine 60 mg/day.

Antimuscarinic drugs are the first line pharmacotherapy for overactive bladder, but they are not always effective to achieve complete continence. Nevertheless in some patients urodynamic investigations reveal insufficient effects with continuing incontinence events even with dose optimization. The aim of this study is to evaluate the effect of association of Oxybutynin chloride, Trospium chloride and Solifenacin succinate administered orally for a minimum of 12 weeks in subjects with suprasacral spinal cord injury with urge-incontinence, urodynamic proven neurogenic detrusor overactivity dysfunction and detrusor-external sphincter dyssynergia to improve level of continence, reduce the risks of urologic complications and enhance QOL. This study was a randomized, double blind, controlled, balanced-parallel-groups investigation of orally administed Oxybutynin in addition to Trospium chloride in the first group and Oxybutynin in addition to Solifenacin in the other group. A total of 12 patients with neurogenic detrusor overactivity and clean intermittent catheterization were allocated into two treatment groups: 5 mg tablet of Oxibutinin and 20 mg tablet of Trospium Chloride were administered respectively 3 times a day and 4 times a day in the first group (Group A). 5 mg tablet of Oxibutinin and 10 mg tablet of Solifenacin were administered respective 3 times a day and once daily in the second group (Group B). In both group of patients we found a significant decrease in incontinence episodes, with an improvement of bladder compliance, bladder capacity and volume voided. Side effects were higher in patients of group B, but in generally well tolerated. In conclusion, a combined antimuscarinic treatment might be a right option for patients affected by neurogenic bladder refractory to previous antimuscarinic monotherapy, and might slow down or delay other more invasive treatments.

It is debated whether the use of herbal supplements in endurance sports, in order to have a better performance, is correct or not, from the perspective of both as safety and as effectiveness. In this review we try to find out if the most common herbal supplements (Echinacea, Rhodiola, Ginseng) are effective in the improvement of performance or in the modulation of the immune system. According to the results of our review, the prevalent effect is adaptogenic rather than ergogenic, with a better tolerance of the exercise induced stress, related to enhancement of the whole immune system and decrease of the oxidative damage.

The paper represents the Italian Society of Physical " and Rehabilitation Medicine (SIMFER) recommendations to Neck Pain. We searched the principal scientific databases for papers concerning the main approaches to NP, including international guidelines, clinical trials of high methodological value and systematic reviews without any temporal limits. The recommendations were graded on the basis of the National Plan for Guidelines of the Italian Istituto Superiore di Sanità, which includes the level of evidence and strength of the recommendation. The principal sections of the recommendations deal with the Evaluation and Therapy for Neck Pain. The first describes the main evidence concerning the evaluation of patients with NP with or without limb involvement and/or headache: medical history, physical examination, neurological examination, laboratory tests, electrodiagnostics, diagnostic imaging and self-administered questionnaires. The second describes the best evidence synthesis concernig the therapy for Neck Pain: education, exercise, medical therapy, manual therapy, traction, physical therapy, acupuncture, orthoses, multimodal treatment, behavioural treatment.

A new preparation of botulinum toxin type A called NT 201, free from complexing proteins, potentially with low antigenicity has been used in the therapy of spasticity in stroke patients. This was an open-label study reported the safety and the efficacy of one-year treatment with NT 201 evaluating the therapeutic effect on functional disability and on quality of life in upper limb spasticity after stroke. Patients received a botulinum toxin therapy in the upper injected intramuscularly. After inoculation, patients were submitted to a motor rehabilitation program for upper limb injected three times/week. Re-treatment was permitted at 12 weeks after the prior treatment. Safety assessment included evaluation of adverse events and efficacy was measured by Modified Ashworth Scale for spasticity (MAS), Spasm Frequency Score (SFS) for the daily spasms, and Disability Assessment Scale (DAS) for disability. Of 35 consecutive patients (13 women and 12 men) screened for study eligibility, 20 (6 women and 14 men) patients (mean age 63,4±7,03) were included in this study and were submitted to NT 201 therapy for one year. At the baseline, botulinum toxin dose in the upper limb ranged from 160 to 450U, whereas total dose in the last treatment administrated was reduced respect the first injections ranging from 120 to 350U. All the enrolled patients completed the year-long study and reported an improvement of clinical picture. MAS, was statistically (px003C;0,001) reduced in all muscles at T1 (mean score ±SD: 2.65±0.67) and T2 (mean score±SD: 2.55±0.60) in comparison to the baseline T0 (mean score±SD: 3.9 ±0.78). Significant reduction (px003C;0,001) from baseline T0 (mean score ±SD: 3.25±0.78) was also noted in SFS at T1 (mean score ±SD: 1.55±0.51) and T2 (mean score±SD :1.30±0.47). The DAS score showed a reduction of the T1score (mean score ±SD: 1.70±0.47) and T2 score (mean score ±SD: 1,40 ±0,50) respect to baseline T0 score (mean score ±SD: 2,65 ±0,48) statistically significant (p≤003C;0,001). No adverse effects were observed in these patients. NT 201 appeared to be an efficacious and well-tolerated long-term treatment option for patients with upper limb spasticity after stroke, obtaining a substantial improvement in functional disability, muscle hypertone, and daily spasms.